29. PBM 101- Why Your Drugs Cost So Much?

In this eye-opening episode, we sit down with pharmacy owner and advocate Jeremy Counts to expose the predatory practices of Pharmacy Benefit Managers (PBMs). Jeremy pulls back the curtain on how these powerful middlemen have systematically exploited the pharmacy industry, leading to skyrocketing drug prices, unsustainable reimbursements for pharmacies, and a healthcare system prioritizing profits over patient care. From gag clauses that prevent pharmacists from informing patients about cheaper options, to vertical integration that allows PBMs to dominate the market, Jeremy lays bare the tactics used to line their own pockets. Listeners will come away with a newfound understanding of the urgent need for legislative action, as Jeremy outlines the Pharmacist Fight Back Act and calls on all pharmacists to get involved in the fight to save their profession. This is a must-listen episode for anyone who wants to understand the true cost of prescription drugs and the forces working against affordable healthcare. Key Takeaway: 1. PBMs use predatory tactics like gag clauses and vertical integration to dominate the pharmacy industry and maximize profits at the expense of patients and pharmacies. 2. The complex web of rebates, fees, and reimbursement practices employed by PBMs has led to artificially inflated drug prices and unsustainable reimbursements for pharmacies. 3. The COVID-19 pandemic exacerbated the challenges faced by pharmacists, as PBMs took advantage of the situation to further cut reimbursements, despite pharmacists' increased workload and personal sacrifices. 4. The Pharmacist Fight Back Act (HR 9096) is a critical piece of legislation that aims to reform PBM practices and protect the pharmacy profession, but it requires widespread pharmacist involvement and advocacy. 5. Pharmacists must get educated, get involved in advocacy efforts like PUTT, and contact their representatives to support the Pharmacist Fought Back Act and fight back against the predatory practices of PBMs. Abbreviations: PBMs: Pharmacy Benefit Managers MAC: Maximum Allowable Cost AWP: Average Wholesale Pricing ACA: Affordable Care Act ••••••••••••••••••••••••••••••••••••••••­­­••••••••••• GUEST: Jeremy Counts Podcast: PBM on the Rocks LinkedIn: https://www.linkedin.com/in/hokiepharm/ Pharmacists United for Truth and Transparency (PUTT): https://www.truthrx.org/ ••••••••••••••••••••••••••••••••••••••••­­­••••••••••• Chapters 00:00 Intro 10:50 PBM breakdown 20:55 Vertical Integration and retaliations 35:42 Pharmacy reimbursement horror 46:22 PBMs taking advantage of the pandemic efforts 50:25 No transparency 59:45 Pharmacy Fight Back Act ••••••••••••••••••••••••••••••••••••••••­­­••••••••••• Follow us on social media ▷Hey Rx Friends, We Got This! https://linktr.ee/Heyrxfriends Instagram: https://www.instagram.com/heyrxfriendswgt TikTok: https://www.tiktok.com/@heyrxfriendswgt YouTube: Hey Friends We Got This ▷Thu https://linktr.ee/empoweredpharmd Instagram: https://www.instagram.com/empowered.pharmd/ LinkedIn: https://www.linkedin.com/in/tn-empowered-pharmd Substack: https://drthurx.substack.com/ ▷Saley: Instagram: https://www.instagram.com/reziprep360 LinkedIn: https://www.linkedin.com/in/straore1 TikTok: https://www.linkedin.com/in/straore1 X: ReziPrep360 YouTube: @ReziPrep360 Business inquiries: [email protected] Disclaimer: All opinions are our own.